Classification of Diseases and Disorders and Guidelines Chapters 4-7 Rebecca Herrera, CCS, CCS-P, CPC
Overview of. Endocrine, Nutritional and Metabolic Diseases Mental and Behavioral Disorders Diseases of the Nervous System Diseases of the Eye and Andexa 2
ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES Gray s Anatomy 1918 http://www.cushing s- help.com/images/e ndocrine.jpg 3
Chapter 4 Categories and Blocks E00-E07 E08-E13 E15-E16 E20-E35 E36 E40-E46 Disorders of thyroid gland Diabetes mellitus Other disorders of glucose regulation and pancreatic internal secretion Disorders of other endocrine glands Intraoperative complications of endocrine system Malnutrition 4
Chapter 4 Categories and Blocks E50-E64 E65-E68 E70-E88 E89 Other nutritional deficiencies Overweight, obesity and other hyperalimentation Metabolic disorders Post-procedural endocrine and metabolic complications and disorders, not elsewhere classified 5
Chapter 4 Facts Diabetes mellitus Combination codes No longer classified as controlled or uncontrolled Inadequately, out of control or poorly controlled coded by type with hyperglycemia 6
Chapter 4 Facts Note: ICD-10-CM s five categories for diabetes mellitus: E08, Diabetes mellitus due to underlying condition E09, Drug or chemical induced diabetes mellitus E10, Type 1 diabetes mellitus E11, Type 2 diabetes mellitus E13, Other specified diabetes mellitus 7
Chapter 4 Facts The diabetes mellitus codes are now combination codes that include: Type of diabetes Body system affected Complications affecting that body system. 8
Chapter 4 Facts As many diabetes codes as are necessary to describe all of the complications of the disease may be used, and should be sequenced based on the reason for a particular encounter. Diabetes codes are no longer classified as controlled or uncontrolled. There is a note in the Index that inadequately controlled, out of control, and poorly controlled are coded to Diabetes, by type, with hyperglycemia. 9
Chapter 4 Facts There is one particular note available in each category except for diabetes mellitus type 1. This note states Use additional code to identify any insulin use (Z79.4). This code would not be assigned with type 1 cases because insulin is required to sustain life. 10
Chapter 4 Facts Coding Note: A note appears in the Tabular under category E09 instructing to Use additional code for adverse effect, if applicable, to identify drug (T36-T65 with fifth or sixth character 5). Use the Drugs and Chemical Table to locate this code. An additional note appears in the Tabular under category E09 instructing to Use additional code to identify any insulin use (Z79.4). 11
Chapter 4 Facts Instructions for coding late effects or sequelae have been expanded in Chapter 4 of ICD-10-CM. For example, Excludes1 notes have been added to some categories between E50-E63 to indicate that the sequelae of the nutritional deficiency are assigned a code from category E64. 12
Chapter 4 Facts BMI = weight in pounds / (height in inches height in inches) 703 (Source: Academy of Nutrition and Dietetics) 13
Chapter 4 Practice Case True or false? In ICD-10-CM, all diabetes mellitus codes require documentation of whether the condition is under control or not. 14
Chapter 4 Practice Case Answer Answer: b. False Rationale: ICD-10-CM classifies diabetes mellitus out of control to diabetes mellitus, by type, with hyperglycemia 15
Chapter 4 Practice Case The patient is a 31-year-old male with a history of type 1 diabetes mellitus and is on 15 units of NPH and 10 units of Regular in the morning, and 10 units of NPH and 5 of Regular in the evening. The patient is currently having symptoms of nausea with severe vomiting. The patient at the same time has had increased frequency of urination and polydipsia. The patient is also severely dehydrated. The patient was hydrated, and, as a result, his blood sugar decreased from more than 600 to normal levels. The patient was diagnosed with diabetic ketoacidosis, type 1. What diagnosis codes are assigned? Code(s): 16
Chapter 4 Practice Case Answer Answer: E10.10 Diabetes, diabetic (mellitus) (sugar), type 1, with, ketoacidosis E86.0 Dehydration Rationale: The reason for the encounter is the diabetic ketoacidosis which would be sequenced first. The symptoms of nausea and vomiting, frequency of urination, and polydipsia would not be coded 17
MENTAL, BEHAVIORAL AND NEURODEVELOPMENTAL DISORDERS Gray s Anatomy 1918 http://www.basicmentaldisorders.com/wpcontent/uploads/2009/08/mental-disorders7.jpg 18
Chapter 5 Categories and Blocks F01-F09 F10-F19 F20-F29 Mental disorders due to known physiological conditions Mental and behavioral disorders due to psychoactive substance use Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders 19
Chapter 5 Categories and Blocks F30-F39 F40-F48 F50-F59 Mood [affective] disorders Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders Behavioral syndromes associated with physiological disturbances and physical factors 20
Chapter 5 Categories and Blocks F60-F69 F70-F79 F80-F89 F90-F98 F99 Disorders of adult personality and behavior Intellectual disabilities Pervasive and specific developmental disorders Behavioral and emotional disorders with onset usually occurring in childhood and adolescence Unspecified mental disorder 21
Chapter 5 Facts Changes were necessary in Chapter 5 because of outdated terminology. For example, the effects of nicotine were discovered in the past 20 years ICD-10-CM contains a separate category F17 for nicotine dependence with subcategories to identify the specific tobacco product and nicotine-induced disorders. ICD-9-CM has a single code, 305.1, for tobacco use disorder or tobacco dependence. 22
Chapter 5 Facts The identification of the stage of the substance use, namely continuous or episodic, is not a part of ICD- 10-CM. A single ICD-10-CM code identifies: the substance the disorder the substance use induced. there continues to be codes for substance dependence in remission. 23
Chapter 5 Facts A history of drug or alcohol dependence is coded as in remission. Further, there are combination codes for drug and alcohol use and associated conditions, such as withdrawal, sleep disorders, or psychosis. There is a code for blood alcohol level (Y90.-) that can be assigned as an additional code when documentation indicates its use. 24
Chapter 5 Facts There is a change in sequencing involving the intellectual disability codes (F70-F79). In ICD-9-CM, an additional code for any associated psychiatric or physical condition(s) should be sequenced after the intellectual disability code. In ICD-10-CM, any associated physical or developmental disorder should be coded first. 25
Chapter 5 Practice Case Joe, a 43-year-old male, is currently receiving treatment for alcohol dependence. As a result of Joe s drinking he is also on medication for chronic alcoholic gastritis. He also has a history of cocaine dependence. What diagnosis codes are assigned? 26
Chapter 5 Practice Case Answer Answer: F10.20 Dependence, (on) (syndrome), alcohol (ethyl) (methyl) (without remission) K29.20 Gastritis (simple), alcoholic F14.21 History, personal (of), drug dependence see Dependence, drug, by type, in remission. Dependence, (on) (syndrome), drug, cocaine, in remission Rationale: The cocaine dependence is coded as in remission because there is not a history code for drug dependence. 27
DISEASES OF THE NERVOUS SYSTEM http://static.ddmcdn.com/gif/brain-nervous-system.gif 28
Chapter 6 Categories and Blocks G00-G09 G10-G14 G20-G26 G30-G32 Inflammatory diseases of the central nervous system Systemic atrophies primarily affecting the central nervous system Extrapyramidal and movement disorders Other degenerative diseases of the nervous system 29
Chapter 6 Categories and Blocks G35-G37 G40-G47 G50-G59 G60-G65 G70-G73 Demyelinating diseases of the central nervous system Episodic and paroxysmal disorders Nerve, nerve root and plexus disorders Polyneuropathies and other disorders of the peripheral nervous system Diseases of myoneural junction and muscle 30
Chapter 6 Categories and Blocks G80-G83 G89-G99 Cerebral palsy and other paralytic syndromes Other disorders of the nervous system 31
Chapter 6 Facts 32
Chapter 6 Facts Comparable to Chapter 6 in ICD-9-CM One change to note is that only diseases of the nervous system are contained in Chapter 6 of ICD- 10-CM. Diseases of the sense organs, namely eye/adnexa and ear/mastoid processes, each now have their own chapter in ICD-10-CM 33
Chapter 6 Facts Categories in Chapter 6 have rephrased titles and in some cases encompass a combination of conditions. Additionally, a number of codes for diseases of the nervous system have been expanded in ICD-10-CM. 34
Chapter 6 Examples Note: Category for Alzheimer s disease (G30) has been expanded to reflect onset (early versus late) ICD-10-CM has two codes for phantom limb syndrome, differentiating whether pain is present or not 35
Chapter 6 Examples Note: Classification of organic sleep disorders have undergone a significant change in ICD-10-CM: First, these disorders are now included in Chapter 6 rather than the signs and symptoms chapter where ICD-9-CM had classified them Second, sleep apnea has its own subcategory (G47.3) with fifth character specificity identifying the type 36
Chapter 6 Examples ICD-10-CM beneath category G89, Pain, not elsewhere classified, there is a note that states code also related psychological factors associated with pain. However, ICD-9-CM category 338, Pain, not elsewhere classified, the note instructs coding professionals to use additional code to identify pain associated with psychological factors (307.89).. 37
Chapter 6 Examples A note at categories G81 (Hemiplegia and hemiparesis), G82 (Paraplegia and quadriplegia) and G83 (Other paralytic syndromes) provides this information: This category is to be used only when the listed conditions are reported without further specification, or are stated to be old or longstanding but of unspecified cause. The category is also for use in multiple coding to identify these conditions resulting from any cause. Paralytic sequelae of cerebral infarct/stroke are in Chapter 9: Diseases of the circulatory system. 38
Chapter 6 Examples The terminology for epilepsy has been updated, with terms to classify the disorder such as: localization-related idiopathic epilepsy, generalized idiopathic epilepsy, special epileptic syndromes. 39
Chapter 6 Examples Within those various categories, more specificity is possible, such as identifying: seizures of localized onset complex partial seizures Intractable status epilepticus 40
Chapter 6 Examples A note with category G40, Epilepsy and recurrent seizures and G43, Migraine provides the following terms to be considered equivalent to intractable: pharmacoresistent (pharmacologically resistant) treatment resistant refractory (medically) poorly controlled. 41
Chapter 6 Practice Case This 52-year-old male has been having increasing dementia and forgetfulness. He has been wandering off and leaving his home and forgetting where he is or where he is going. The diagnosis of dementia due to early-onset Alzheimer s was established. What diagnosis codes are assigned? 42
Chapter 6 Practice Case Answer Answer: G30.0 Alzheimer s disease or sclerosis, see Disease, Alzheimer s, early onset, with behavioral disturbance F02.81 Dementia, in Alzheimer s disease, see Disease, Alzheimer s Z91.83 Wandering, in diseases classified elsewhere 43
Chapter 6 Practice Case Answer Rationale: There is mandatory sequencing for these codes. The etiology (Alzheimer s disease) is sequenced first and the manifestation (dementia) is sequenced second. The Index provides the following documentation: Alzheimer s, early onset, with behavioral disturbance G30.0 [F02.81]. 44
Chapter 6 Practice Case Answer Rationale: The use of the brackets in the Index indicates manifestation codes. Further the note in the Tabular at the G30 category states to use an additional code to identify dementia with behavioral disturbance (F02.81). At the F02 category, the note states to Code first the underlying physiological condition. The dementia is coded with behavioral disturbance because of the documentation of wandering off. At code F02.81, the note states to Use additional code, if applicable, to identify wandering 45
DISEASES OF THE EYE AND ADNEXA http://www.bing.com/images/search?q=eye+and+ocular+adnexa& FORM=RESTAB&adlt=strict#view=detail&id=5126C13F8E96D0C5BA D485877401FA5ECCCA0112&selectedIndex=83 46
Chapter 7 Categories and Blocks H00-H05 H10-H11 H15-H22 H25-H28 H30-H36 H40-H42 Disorders of eyelid, lacrimal system and orbit Disorders of conjunctiva Disorders of sclera, cornea, iris and ciliary body Disorders of lens Disorders of choroid and retina Glaucoma 47
Chapter 7 Categories and Blocks H43-H44 H46-H47 H49-H52 H53-H54 Disorders of vitreous body and globe Disorders of optic nerve and visual pathways Disorders of ocular muscles, binocular movement, accommodation and refraction Visual disturbances and blindness 48
Chapter 7 Categories and Blocks H55-H57 H59 Other disorders of eye and adnexa Intraoperative and post-procedural complications and disorders of eye and adnexa, not elsewhere classified 49
Chapter 7 Facts Entirely new chapter in ICD-10-CM. ICD-9-CM classified these conditions in Chapter 6: Diseases of the Nervous System and Sense Organs. Chapter 7 in ICD-10-CM also has a different organization than what is found in ICD-9-CM. While the structure is still by site for diseases of the eye and adnexa, the order differs. 50
Chapter 7 Facts Categories in Chapter 7 have undergone title changes to reflect the terminology used today. For example, ICD-9-CM uses senile cataract while ICD-10-CM utilizes the descriptor age-related cataract. Many of the classification changes have to do with the expansion of characters to provide for laterality. ICD-10-CM contains codes for right side, left side, and in some instances bilateral sides 51
Chapter 7 Example H16.01 Central corneal ulcer H16.011, Central corneal ulcer, right eye H16.012, Central corneal ulcer, left eye H16.013, Central corneal ulcer, bilateral H16.019, Central corneal ulcer, unspecified eye 52
Chapter 7 Facts Note: Under ICD-10-CM subcategory H47.5, Disorders of other visual pathways, is a note to code also the underlying condition. This differs from ICD-9-CM in that a single code is used to identify the visual pathway disorder and the associated condition. 53
Chapter 7 Facts Note: Under ICD-10-CM subcategory H54, Blindness and low vision, is a note to code first any associated underlying cause of the blindness. No such note appears under ICD-9-CM category 369, Blindness and low vision. 54
Chapter 7 Practice Case Code the following diagnosis: Recurrent pterygium, bilateral. 55
Chapter 7 Practice Case Answer Answer: H11.063 Pterygium (eye), recurrent. See Tabular for correct code assignment. Rationale: Pterygium is a non-cancerous growth of the clear, thin tissue that lies over the conjunctiva. No treatment is required unless the pterygium begins to block vision. ICD-10-CM provides codes to identify pterygium of the left, right, or bilateral eyes. 56
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